Provider Demographics
NPI:1073973509
Name:BROWN, JARED (PT,DPT)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4046 MISSISSIPPI ST
Mailing Address - Street 2:1
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-2469
Mailing Address - Country:US
Mailing Address - Phone:619-260-0750
Mailing Address - Fax:
Practice Address - Street 1:5030 CAMINO DE LA SIESTA
Practice Address - Street 2:#220
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3116
Practice Address - Country:US
Practice Address - Phone:619-260-0750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-25
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43432225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist